Phase 3 Mod 2 Deck 1 Flashcards
_________ is a medical reason not to give a medication.
Contraindication
__________ is the movement of the limbs toward the medial plane of the body or the axial line of a limb.
Adduction
adding to the body
_________ is the level of a medication in the blood in which tissue damage is likely.
Toxic level
What is the maximum recommended daily dose of acetaminophen?
3g
3,000 mg
What is penicillinase?
An enzyme produced by penicillin resistant bacterium which blocks penicillin inside the bacterium.
What is the approximate dose of toxicity associated with a single dose of acetaminophen ingestion?
Approximately 7 - 10 grams
150 mg/kg
How many points should NSAIDs be expected to lower pain on the 0-10 pain scale?
Lowered by 1-2 points
Ex. If pain was a 7, NSAIDs should lower pain to 5
__________ is an inflammation of the tendons that join the forearm muscles on the inner and outer aspects of the elbow.
Epicondylitis
***The elbow joint is made up of the humerus and ulna. The bony prominences at the distal portion of the humerus are called the epicondyles.
What is the most common cause of shoulder dislocations?
Falling
_________ are broad spectrum antibiotics that are effective against both gram-positive and gram-negative bacterium.
Macrolides
Which classification of medications is commonly utilized for patients suffering from acute asthmatic exacerbations?
Corticosteroids
What is diffusion?
The flow of gas or liquid from an area of higher concentration to an area of lesser concentration.
What are the two types of cyclo-oxygenase (COX)?
COX 1 - involved in the formation of prostaglandins that maintain the integrity of the gastrointestinal mucosa.
COX 2 - is made primarily in response to injury or inflammation and is involved in the formation of prostaglandins which cause inflammation.
_________ is the variable levels of a medication within the blood, between the therapeutic level and the toxic level.
Therapeutic range
Some medications have a “narrow” therapeutic range and require very close monitoring
What is the approximate half-life of Narcan?
0.5 - 1.5 hours
30 - 90 minutes
After a rapid ascent, your patient develops signs of dyspnea while at rest, cyanosis, rales, and tachypnea. What form of altitude sickness should you suspect?
HAPE - High Altitude Pulmonary Edema
Their are three anatomical planes of the human body. What are they?
- Sagittal (vertical): equal left and right halves
- Coronal (frontal): front and back plane
- Axial (transverse): upper and lower (midline; waist)
What classification of medications are commonly prescribed for acute back pain and/or spasms?
Muscle relaxers
- Methocarbamol (Robaxin)
- Cyclobenzaprine (Flexeril)
Why are different bacterias determined to be either gram-positive or gram-negative?
Different classes of bacteria require different antibiotics or different dosing because of their own metabolism.
_________ is the study of substances that interact with living organisms through chemical processes.
Pharmacology
What is the approximate half-life of morphine sulfate?
2 - 3 hours
120 - 180 minutes
What is the approximate half-life of ketamine?
2.5 hours
150 minutes
What is a gradient?
The difference in pressures from the high concentration to the lower concentration.
How many generations of cephalosporins are there?
Four:
- 1st: gram-positive bacterium (cefazolin, cephalexin)
- 2nd: gram-positive bacterium (cefuroxime)
- 3rd: gram-positive/negative bacterium (Rocephin)
- 4th: gram-positive/negative bacterium (cefipme)
Which anatomical plane separates the body into superior and inferior portions?
Axial (transverse)
upper and lower (midline; waist)
What is tendon attrition?
Weakening of the tendons
could be caused by bone spurs rubbing together
Which anatomical plane separates the body into anterior and posterior portions?
Coronal (frontal)
front and back plane
Topical corticosteroids are categorized in groups by strength from 1 - 7. Which end of the spectrum is the strongest? Which end of the spectrum is the weakest?
1 is the strongest (prescription); 7 is the weakest (OTC)
How does penicillin work?
Inhibiting cell wall production of peptidoglycan
against gram-positive, aerobic organisms
__________ is a cerebral and/or pulmonary syndrome(s) that can develop in unacclimatized persons shortly after ascent to high altitude.
High Altitude Illness
_________ is when a medication is at its highest concentration (maximum benefit).
Peak
Which analgesic medication is known to potentially cause severe hypotension in an individual whose ability to maintain blood pressure has already been compromised by depleted blood volume?
Morphine
Morphine may produce orthostatic hypotension and syncope in ambulatory patients
_________ is the time until the medication’s therapeutic effect wears off.
Duration of therapy
_________ the reasons or conditions for which a particular medication is given.
Indication
How many bones are their in the wrist?
Eight
What is the recommended adult dose of Tramadol (Ultram)?
50 - 100 mg q 4-6 hours
maximum dose: 400 mg/daily
__________ is the difference in pressures from the high concentration to the lower concentration.
Gradient
What is the best way to speed up acclimatization?
There isn’t one
Antibiotics:
What type of bacteria is penicillin effective against?
Gram-positive, aerobic organisms
__________ is the act of turning the palm posteriorly (backward) or inferiorly (downward) by medially rotating the forearm.
Pronation
laying prone
At low adult doses, which medication relieves pain twice as well as morphine?
Ketamine
_________ is the lowest level of medication in the blood in between dosages.
Trough
How long does the treatment for HAPE last while in a Gamow bag?
HAPE - High Altitude Pulmonary Edema:
Approximately 4 hours
_________ is the amount of medication given at or within a specified period of time.
Dose
__________ is acute swelling of the brain due to rapid ascent in altitude.
High Altitude Cerebral Edema (HACE)
Why don’t antibiotics work on fungi?
Antibiotics work by disrupting the chemical processes of bacteria and inhibit reproduction. Fungi however can reproduce either sexually or asexually.
_________ is the time until a medication’s therapeutic effect wears off.
Onset
_________ is the amount of medication per form of delivery (tablet, capsule, etc.).
Strength
- Gm, Mg, Mcg - solids*
- ** mL - fluids***
Which type of shoulder dislocation (direction wise) is the most common treated?
Anterior dislocations (98%)
_________ is a relative constant blood level of medication which is sustained after 5-6 half-lives of medication.
Steady state
__________ have a slower onset and longer duration, having been compounded with inhaled steroids for long-term control of asthma.
Long Acting Beta Agonists (LABA)
__________ requires people to ascend (rise) to a moderate altitude and remain there for 3 days or more to acclimatize before ascending higher.
Staged Ascent
***When possible, Soldiers should make several stops for staging during the ascent to allow a greater degree of acclimatization.
What is a common symptom of a patient suffering from HACE?
High Altitude Cerebral Edema: Ataxia (lack of coordination)
* to include altered mental status with headache, fatigue, nausea and/or vomiting*
__________ includes any type of irritation or damage to your rotator cuff muscles or tendons.
Rotator cuff injuries
When do symptoms of Acute Mountain Sickness (AMS) usually develop?
6-10 hours after ascent
_________ - all of the limitations, considerations and instructions required, regarding a medication, to help achieve the desired physiological response while minimizing side effects.
Dosing parameters
What is the primary organ that metabolizes acetaminophen?
Liver
__________ is the movement of the forearm in which the palm faces up anteriorly.
Supination
holding a cup of soup
What is the antidote for acute acetaminophen toxicity?
N-Acetylcysteine
Mucomyst
__________ limits the daily altitude gain to allow partial acclimatization.
Example: Begin at 9,000 ft and limit the sleeping altitude to no more than 1,000 ft per day above the previous night’s sleeping altitude.
Graded Ascent
The altitude at which Soldier’s sleep is the critical element in this regard
__________ is a partial or incomplete dislocation.
Subluxation
How is medial epicondylitis pain reproduced?
With flexion and pronation
__________ is the movement of the limbs toward the lateral plane or away the axial line of a limb.
Abduction
abducted from the body
How long does the treatment for Acute Mountain Sickness last while in a Gamow bag?
Approximately 2 hours
What is the primary organ injured subsequent to acetaminophen overdose?
Liver
_________ occurs when infectious organisms adapt to antibiotics or antivirals and it takes either higher doses of the same medication or a change to different medication to kill the organism.
Resistance
_________ is the process of the body breaking down and eliminating medications.
Metabolism
most medications are metabolized by the liver or kidneys
__________ is a displacement of a bone from a joint.
Dislocation
What is the average dosage range that morphine is titrated between?
5 - 20 mg
What is the likely effectiveness of an antibiotic on a virus or fungus?
Ineffective
__________ is inadequate oxygen content in the blood.
Hypoxia (also called hypoxemia)
_________ is an immune response in which there is a hypersensitivity response induced by exposure to a particular medication, which could be life threatening in certain circumstances.
Allergy
What is a common side effect of pseudoephedrine that medics should be cognizant of?
Potential to elevate blood pressure
The term eustachian refers to the __________.
Ears
_________ occurs when medication is administered in variable strength, interval, and quantity to achieve and maintain a desired, observable physiological effect.
Titration (titrate to effect)
__________ are portable pressure chambers used to treat casualties with high altitude sickness disorders.
Gamow bag(s)
What does “comorbidities” refer to?
Other medical problems, besides the reason the current medication is being administered, which may affect metabolism or may make the patient more susceptible for a side effect or toxicity.
__________ rapidly open the bronchi and are useful in acute cases such as asthma attacks in asthmatics..
Short Acting Beta Agonists (SABA)
__________ is acute accumulation of fluid in the alveoli due to rapid ascent in altitude.
High Altitude Pulmonary Edema (HAPE)
How long does the treatment for HACE last while in a Gamow bag?
HACE - High Altitude Cerebral Edema
Approximately 6 hours
What is pharmacology?
Pharmacology is the study of substances that interact with living organisms through chemical processes.
What are the three main factors that affect medication dosages?
- Body weight
- Comorbidities
- Age
_________ is an unintended, but not-surprising consequence of a medication (besides an allergy) which may require a medication dose be changed or discontinued.
Side effect
__________ is the painful inflammation of the tendons on the inner aspect of the elbow.
Medial epicondylitis (golfer’s elbow)
aka wrist flexor tendonitis or elbow tendonitis
_________ is the science of substances used to prevent, diagnose, and treat diseases.
Medical pharmacology
_________ occurs when the body has adapted to having a medication regularly and now requires higher or more frequent doses to achieve the therapeutic effect.
Tolerance
At high doses, which medication dissociates conscious thought from sensory input, including pain (Patient just doesn’t care).
Ketamine
What are the two categories of contraindications?
- Absolute - medical reason to NEVER give medication
2. Relative - medical reason a medication should not be given, but may be acceptable in certain circumstances.
Why should the use of oxymetazoline (Afrin) be limited to 3 days or less?
Use greater then 3 days may result in rhinitis medicamentosa, where the nasal membranes are dependent on the medication.
What gland produces cortisol, which is an anti-inflammatory steroid?
Adrenal gland
What is the most effective way to prevent high altitude illnesses and achieve maximum acclimatization?
Combine the staged ascent and graded ascent
Gram _________ indicates that the cell membrane outer structure consists of a cytoplasmic membrane surrounded by a thin layer of peptidoglycan.
Gram-negative
due to the thin layer of peptidoglycan, the bacterium does NOT retain the color of the gram staining
_________ is the range of acceptable DOSAGES of a medication needed to keep blood levels within the therapeutic range.
Therapeutic window
Some medications have a “narrow” therapeutic window and require very close monitoring
__________ is the process whereby the body gradually adapts to the climate and environment.
Acclimatization
_________ is the blood level of a medication required to achieve the therapeutic effect.
Therapeutic level
Which class of antibiotics are know to stimulate motilin receptors in the gastrointestinal tract and cause diarrhea?
Macrolides
What medication can be used to help patients suffering from some degree of altitude sickness (AMS, HAPE, HACE)?
Diamox (acetazolamide) 250 mg PO q 8-12 hrs
What are the two methods for achieving acclimatization?
- Staged Ascent
2. Graded Ascent
_________ is a substance that forms a tough, rigid structure of the bacterium wall.
Peptidoglycan
- indicates gram-positive bacteria*
- due to the thick layer of peptidoglycan, the bacterium retains the color of the gram staining*
What medication is used as an opioid antagonist?
Narcan (naloxone)
What are the TWO main key concerns (side effects) when administering morphine sulfate?
- Respiratory depression
2. Hypotension
What is the primary cause of death subsequent to toxic acetaminophen ingestion?
Liver failure (usually within 1 week)
What are the two categories that gram-stain testing places bacteria in?
- Gram-postive
2. Gram-negative
__________ is a syndrome due to rapid ascent in altitude consisting of headache, nausea, vomiting, and fatigue.
Acute Mountain Sickness (AMS)
What is Methocarbamol (Robaxin) and Cyclobenzaprine (Flexeril) primarily prescribed for?
Acute back pain and/or spasms
What do corticosteroids simulate?
Cortisol, which is an anti-inflammatory steroid produced in the adrenal gland.
_________ is the time it takes for the body to eliminate 1/2 of the medication dose.
Half-life
***Ex: Benadryl has a half-life of nine hours. If a PT takes 50 mg at 21:00, then nine hours later (06:00), the PT still has 25 mg in his/her system. Nine hours after that (15:00), the PT has 12.5 mg in his/her system.
What is the standard dose for Narcan?
0.4 - 2.0 mg IV, IO, ET (x2 dose)
Why is it recommended that patients rinse their mouth after using a corticosteroid inhaler?
To reduce the risk of oral candidiasis (thrush)
_________ is the recommended time period between doses of a medication.
Dosing interval
Meloxicam (Mobic) is an example of which type of NSAID?
Cyclo-oxygenase 2
COX-2
__________ is movement that decreases the angle between two articulating bones, bending the limb.
Flexion
Other medical problems, besides the reason the current medication is being administered, which may affect metabolism or may make the patient more susceptible for a side effect or toxicity is defined as:
Comorbidities
The management of which form of high altitude sickness includes the use of Dexamethasone (4 mg PO, IM or IV q 6 hrs) and/or Nifedipine ‘Procardia’ (10 mg gel caps)
HAPE - High Altitude Pulmonary Edema
Which NSAID is prohibited in combat theaters except in cases of medical necessity?
Aspirin (ASA)
due to concern of worse hemorrhaging due to its affects on platelet formation
__________ is a fluid-filled cavity near joints, where tendons or muscles pass over bony projections.
Bursitis (bursea)
__________ is a localized or generalized excessive amount of tissue fluid (swelling).
Edema
Which medications are intended to kill or inhibit the reproduction of bacteria?
Antibiotics
__________ is movement that increases the angle between two adjoining bones.
Extension
Gram _________ indicates the presence of peptidoglycan.
Gram-positive
__________ is the painful inflammation of the tendons on the outer aspect of the elbow.
Lateral epicondylitis (tennis elbow)
aka wrist extensor tendonitis or elbow tendonitis
Which analgesic medication is chemically related to phencyclidine (aka PCP or Angel Dust) but has very potent analgesic and dissociative effects?
Ketamine
__________ is the pressure of one particular gas in a gas mixture (such as the pressure of just oxygen mixed in the atmosphere).
Partial Pressure
Which classification of medications block cyclo-oxygenase?
NSIADs
_________ is involved in the formation of prostaglandins that maintain the integrity of the gastrointestinal mucosa.
Cyclo-oxygenase 1
(COX-1)
Non-selective NSAIDs
Which anatomical plane separates the body into left and right sides?
Sagittal (vertical)
What is a positive Sulcus sign? What type of injury does it suggest?
Sulcus sign is suggestive of a shoulder dislocation due to a pocket (or void) where the shoulder joint should be (if positive).
the pocket is caused by negative pressure
_________ is the desired change in physiology for administering the medication.
Therapeutic effect
Erythromycin and azithromycin are examples of which antibiotic?
Macrolides
What are the three categories of patient dosages?
- Single dose - amount of medication administered at one time.
- Maximum dose - the largest amount of medication either as a single dose or within a period of time such as 24 hours.
- Cumulative dose - the sum of all single doses over either a lifetime or a period of time.
How doe NSAIDs work?
NSAIDs block cyclo-oxygenase (COX)
__________ is the largest carpal bone in the wrist and the most likely to fracture.
Scaphoid
FOOSH (Fall On Outstretched Hand) injuries
